HLS 12RS-997 ORIGINAL
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Regular Session, 2012
HOUSE BILL NO. 908
BY REPRESENTATIVE RITCHIE
INSURANCE/HEALTH: Provides relative to health insurance rate review and approval
AN ACT1
To amend and reenact R.S. 22:972, Subpart D of Part III of Chapter 4 of Title 22 of the2
Louisiana Revised Statutes of 1950, to be comprised of R.S. 22:1091 through 1099,3
and R.S. 44:4.1(B)(10), and to enact R.S. 22:821(B)(34), relative to health4
insurance rate review and approval; to provide for definitions; to provide for5
applicability; to provide relative to form approval; to modify community rating; to6
provide with respect to review and subsequent approval or disapproval of proposed7
premium rate filings and rate changes; to provide for fees; to provide for exceptions8
to the Public Records Law; to provide for implementation and enforcement; to9
prohibit certain discrimination in rates; to provide for transitional provisions by10
providing for various effective dates; and to provide for related matters.11
Be it enacted by the Legislature of Louisiana:12
Section 1. R.S. 22:972 and Subpart D of Part III of Chapter 4 of Title 22 of the13
Louisiana Revised Statutes of 1950, comprised of R.S. 22:1091 through 1099, are hereby14
amended and reenacted and R.S. 22:821(B)(34) is hereby enacted to read as follows: 15
§821. Fees16
* * *17
B. The following fees and licenses shall be collected in advance by the18
commissioner of insurance:19
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(34)Fee for premium rate filings for health insurance issuers1
(a)New premium rate filings.......................$ 100.002
(b)Rate changes.................................$ 150.003
* * *4
§972. Approval and disapproval of forms; filing of rates5
A. No policy or subscriber agreement of a health and accident insurance6
issuer, including a health maintenance organization, shall be delivered or issued for7
delivery in this state, nor shall any endorsement, rider, or application which becomes8
a part of any such policy, which may include a certificate, be used in connection9
therewith until a copy of the form and of the premium rates and of the classifications10
of risks pertaining thereto have been filed with the commissioner of insurance; nor11
shall any such department. No policy, subscriber agreement, endorsement, rider, or12
application shall be used until the expiration of forty-five sixty days after the form13
has been filed unless the commissioner of insurance department gives his its written14
approval prior thereto. The commissioner of insurance shall notify in writing the15
insurer which has filed any such form if it does not comply with the provisions of16
this Subpart, specifying the reasons for his opinion; and it shall thereafter be17
unlawful for such insurer to issue such form in this state. Written notification shall18
be provided to the health insurance issuer specifying the reasons a policy form or19
subscriber agreement does not comply with the provisions of this Subpart. It shall20
be unlawful for any health insurance issuer to issue any form in this state not21
previously submitted to and approved by the department. An aggrieved party22
affected by the commissioner's department's decision, act, or order in reference to a23
policy form or subscriber agreement may demand a hearing in accordance with24
Chapter 12 of this Title, R.S. 22:2191 et seq.25
B. After providing twenty days' notice to the commissioner of health26
insurance issuer, the department may withdraw his its approval of any such policy27
form or subscriber agreement or on any of the grounds stated in this Section R.S.28
22:862. It shall be unlawful for the insurer health insurance issuer to issue such29 HLS 12RS-997 ORIGINAL
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policy form or subscriber agreement or use it in connection with any policy or1
subscriber agreement after the effective date of such withdrawal of approval. An2
aggrieved party affected by the commissioner's department's decision, act, or order3
in reference to a policy form or subscriber agreement may demand a hearing in4
accordance with Chapter 12 of this Title, R.S. 22:2191 et seq.5
C. The commissioner of insurance department shall not disapprove or6
withdraw approval of any such policy form or subscriber agreement on the ground7
that its provisions do not comply with R.S. 22:975 or on the ground that it is not8
printed in uniform type if it shall be shown that the rights of the insured, or the9
beneficiary, or the subscriber under the policy or subscriber agreement as a whole10
are not less favorable than the rights provided by R.S. 22:975 and that the provisions11
or type size used in the policy or subscriber agreement are required in the state,12
district, or territory of the United States in which the insurer the health insurance13
issuer is organized, anything in this Subpart to the contrary notwithstanding.14
D. All premium rates referenced in this Section are to be controlled by15
Subpart D of this Part, R.S. 22:1091 through 1099.16
* * *17
SUBPART D. RATES RATE REVIEW AND APPROVAL18
§1091. Health insurance plans subject to rate limitations review and approval19
A. The provisions of R.S. 22:1091 through 1095 shall apply to any health20
benefit plan which provides coverage to a small employer except the following:21
(1) An Archer medical savings account that meets all requirements of22
Section 220 of the Internal Revenue Code of 1986.23
(2) A health savings account that meets all requirements of Section 223 of24
the Internal Revenue Code of 1986.25
B. Notwithstanding any law to the contrary, the following terms shall be26
defined as follows:27
(1) "Actuarial certification" means a written statement by a member of the28
American Academy of Actuaries that a small employer carrier is in compliance with29 HLS 12RS-997 ORIGINAL
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the provisions of R.S. 22:1092, based upon the person's examination, including a1
review of the appropriate records and of the actuarial assumptions and methods2
utilized by the carrier in establishing premium rates for applicable health benefit3
plans.4
(2) "Base premium rate" means, for each class of business as to a rating5
period, the lowest premium rate charged or which could have been charged under a6
rating system for that class of business, by the small employer carrier to small7
employers with similar case characteristics for health benefit plans with the same or8
similar coverage.9
(3) "Carrier" means an insurance company, including a health maintenance10
organization as defined and licensed to engage in the business of insurance under11
Subpart I of Part I of Chapter 2 of this Title, which is licensed or authorized to issue12
individual, group, or family group health insurance coverage for delivery in this13
state.14
(4) "Case characteristics" mean demographic or other relevant characteristics15
of a small employer, as determined by a small employer carrier, which are16
considered by the carrier in the determination of premium rates for the small17
employer. Claim experience, health status and duration of coverage since issue are18
not case characteristics for the purposes of this Section.19
(5) "Class of business" means all or a distinct grouping of small employers20
as shown on the records of the small employer carrier.21
(a) A distinct grouping may only be established by the small employer22
carrier on the basis that the applicable health benefit plans:23
(i) Are marketed and sold through individuals and organizations which are24
not participating in the marketing or sale of other distinct groupings of small25
employers for such small employer carrier;26
(ii) Have been acquired from another small employer carrier as a distinct27
grouping of plans; or28 HLS 12RS-997 ORIGINAL
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(iii) Are provided through an association with membership of not less than1
twenty-five small employers which has been formed for purposes other than2
obtaining insurance.3
(b) A small employer carrier may establish no more than two additional4
groupings under each of the items in Subparagraph (a) of Paragraph (5) of this5
Subsection on the basis of underwriting criteria which are expected to produce6
substantial variation in the health care costs.7
(c) The commissioner may approve the establishment of additional distinct8
groupings upon application to the commissioner and a finding by the commissioner9
that such action would enhance the efficiency and fairness of the small employer10
insurance marketplace.11
(6) "Health benefit plan", "plan", or "health insurance coverage" means12
benefits consisting of medical care, provided directly, through insurance or13
reimbursement, or otherwise and including items and services paid for as medical14
care, under any hospital or medical service policy or certificate, hospital or medical15
service plan contract, preferred provider organization, or health maintenance16
organization contract offered by a health insurance issuer. However, a "health17
benefit plan" shall not include limited benefit and supplemental health insurance;18
coverage issued as a supplement to liability insurance; workers' compensation or19
similar insurance; or automobile medical-payment insurance.20
(7) "Health savings accounts" are those accounts for medical expenses21
authorized by 26 USC 220 et seq.22
(8) "High deductible health plan" means a high deductible health plan or23
policy that is qualified to be used in conjunction with a health savings account,24
medical savings account, or other similar program authorized by 26 USC 220 et seq.25
(9) "Index rate" means for each class of business for small employers with26
similar case characteristics the arithmetic average of the applicable base premium27
rate and the corresponding highest premium rate.28 HLS 12RS-997 ORIGINAL
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(10) "Medical savings account policy" means a high deductible health plan1
which is qualified to be used in conjunction with a medical savings account as2
provided in 26 USC 220 et seq.3
(11) "New business premium rate" means, for each class of business as to4
a rating period, the premium rate charged or offered by the small employer carrier5
to small employers with similar case characteristics for newly issued health benefits6
plans with the same or similar coverage.7
(12) "Rating period" means the calendar period for which premium rates8
established by a small employer carrier are assumed to be in effect, as determined9
by the small employer carrier.10
(13) "Small employer" means any person, firm, corporation, partnership, or11
association actively engaged in business which, on at least fifty percent of its12
working days during the preceding year, employed no less than three nor more than13
thirty-five eligible employees, the majority of whom were employed within this14
state, and is not formed primarily for purposes of buying health insurance, and in15
which a bona fide employer-employee relationship exists. In determining the16
number of eligible employees, companies which are affiliated companies or which17
are eligible to file a combined tax return for purposes of state taxation shall be18
considered one employer. An employer group of one shall be considered individual19
insurance under this Section.20
(14) "Small employer carrier" means any carrier which offers health benefit21
plans covering the employees of a small employer.22
C. Group and individual high deductible health plans are excluded from the23
provisions of R.S. 22:1091 through 1095.24
A. The provisions of this Subpart shall apply to any health benefit plan25
which provides coverage for a large group, individual, or small group, including any26
policy or subscriber agreement, covering residents of this state. The provisions shall27
apply regardless of where such policy or subscriber agreement was issued or28
delivered and shall include any employer, association, or a trustee of a fund29 HLS 12RS-997 ORIGINAL
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established by an employer, association, or trust for multiple associations who shall1
be deemed the policyholder, covering one or more employees of such employer, one2
or more members or employees of members of such association or multiple3
associations, for the benefit of persons other than the employe r, the association, or4
the multiple associations, as well as their officers or trustees. The provisions of R.S.5
22:1091 through 1097 shall not apply to the following:6
(1) An Archer medical savings account that meets all requirements of7
Section 220 of the Internal Revenue Code of 1986.8
(2) A health savings account that meets all requirements of Section 223 of9
the Internal Revenue Code of 1986.10
(3) Group and individual high deductible health plans.11
(4) Excepted benefits.12
(5) Grandfathered health plans.13
B. Notwithstanding any law to the contrary, for purposes of this Subpart:14
(1) "Actuarial certification" means a written statement signed by a member15
of the American Academy of Actuaries that a health insurance issuer is in16
compliance with the provisions of this Subpart, based upon the actuary's17
examination, including a review of the appropriate records and of the actuarial18
assumptions and methods utilized by the health insurance issuer in establishing19
premium rates for applicable health benefit plans.20
(2) "Base premium rate" means, for each class of business as to a rating21
period, the lowest premium rate charged or which could have been charged under a22
rating system for that class of business, by the small employer health insurance23
issuer to small employers with similar case characteristics for health benefits plans24
with the same or similar coverage. Coverage and case characteristic variations in the25
manual shall bear a reasonable relationship to normal expectations based on26
experience of standard risks. The use of experience alone is not sufficient27
justification for variations beyond such expectations.28 HLS 12RS-997 ORIGINAL
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(3) "Case characteristics" mean demographic or other relevant characteristics1
of a small employer, as determined by a small employer health insurance issuer,2
which are considered by the health insurance issuer in the determination of premium3
rates for the small employer. Claim experience, health status, and duration of4
coverage since issue are not case characteristics for purposes of this Subpart.5
(4) "Class of business" means all or a distinct grouping of small employers6
as shown on the records of the small employer health insurance issuer.7
(a) A distinct grouping may only be established by the small employer health8
insurance issuer on the basis that the applicable health benefit plans meets at least9
one of the following criteria:10
(i) Are marketed and sold through individuals and organizations which are11
not participating in the marketing or sale of other distinct groupings of small12
employers for such small employer health insurance issuer.13
(ii) Have been acquired from another small employer health insurance issuer14
as a distinct grouping of plans.15
(iii) Are provided through an association with membership of not less than16
twenty-five small employers which has been formed for purposes other than17
obtaining insurance.18
(b) A small employer health insurance issuer may establish no more than two19
additional groupings under each of the items in Subparagraph (B)(4)(a) of this20
Section on the basis of underwriting criteria which are expected to produce21
substantial variation in the health care costs.22
(c) The commissioner may approve the establishment of additional distinct23
groupings upon application to him and a finding by him that such action would24
enhance the efficiency and fairness of the small employer insurance marketplace.25
(5) "Excepted benefits" means under one or more of the following:26
(a) Benefits not subject to requirements:27
(i) Coverage only for accident, or disability income insurance, or any28
combination.29 HLS 12RS-997 ORIGINAL
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(ii) Coverage issued as a supplement to liability insurance.1
(iii) Liability insurance, including general liability insurance and automobile2
liability insurance.3
(iv) Workers' compensation or similar insurance.4
(v) Automobile medical payment insurance.5
(vi) Credit-only insurance.6
(vii) Coverage for on-site medical clinics.7
(viii) Other similar insurance coverage, specified in regulations issued by the8
commissioner pursuant to the Administrative Procedure Act, under which benefits9
for medical care are secondary or incidental to other insurance benefits.10
(b) Benefits not subject to requirements if offered separately:11
(i) Limited scope dental or vision benefits.12
(ii) Benefits for long-term care, nursing home care, home health care,13
community-based care, or any combination thereof.14
(iii) Such other similar, limited benefits as specified in reasonable15
regulations issued by the commissioner.16
(c) Benefits not subject to requirements if offered as independent,17
non-coordinated benefits:18
(i) Coverage only for a specified disease or illness.19
(ii) Hospital indemnity or other fixed indemnity insurance.20
(d) Benefits not subject to requirements if offered as a separate insurance21
policy:22
(i) Medicare supplemental health insurance as defined by Section 1882(g)(1)23
of the Social Security Act.24
(ii) Insurance coverage supplemental to military health benefits.25
(iii) Similar supplemental coverage provided under a group health plan.26
(6) "Excessive" means the premium charged for the health insurance27
coverage is considered to be unreasonably high in relation to the benefits provided28
under the particular product. In determining whether the premium rate is29 HLS 12RS-997 ORIGINAL
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unreasonably high in relation to the benefits provided, the department will consider1
each of the following:2
(a) Whether the premium rate results in a projected medical loss ratio below3
the federal medical loss ratio standard in the applicable market to which the premium4
rate applies, after accounting for any adjustments allowable under federal law; 5
(b) Whether one or more of the assumptions on which the premium rate is6
based is not supported by substantial evidence.7
(c) Whether the choice of assumptions or combination of assumptions on8
which the premium rate is based is unreasonable.9
(7) "Federal review threshold" means any rate increase that results in a ten10
percent or greater rate increase, or such other threshold as required by federal law,11
regulation, or directive by the United States Department of Health and Human12
Services, or any premium rate that, when combined with all rate increases and13
decreases during the previous twelve- month period would result in an aggregate ten14
percent or greater rate increase.15
(8) "Grandfathered health plan" has the same meaning as that in 45 C.F.R.16
147.140.17
(9) "Health benefit plan", "plan", "benefit", or "health insurance coverage"18
means services consisting of medical care, provided directly, through insurance or19
reimbursement, or otherwise, and including items and services paid for as medical20
care under any hospital or medical service policy or certificate, hospital or medical21
service plan contract, preferred provider organization, or health maintenance22
organization contract offered by a health insurance issuer. However, excepted23
benefits are not included as a "health benefit plan".24
(10) "Health insurance issuer" means any entity that offers health insurance25
coverage through a policy, certificate of insurance, or subscriber agreement subject26
to state law that regulates the business of insurance. A "health insurance issuer"27
shall include a health maintenance organization, as defined and licensed pursuant to28
Subpart I of Part I of Chapter 2 of this Title.29 HLS 12RS-997 ORIGINAL
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(11) "Health savings accounts" are those accounts for medical expenses1
authorized by 26 U.S.C. 220 et seq.2
(12) "High deductible health plan" means a high deductible health plan or3
policy that is qualified to be used in conjunction with a health savings account,4
medical savings account, or other similar program authorized by 26 U.S.C. 220 et5
seq.6
(13) "Inadequate" means premium rates for a particular product are clearly7
insufficient to sustain projected losses and expenses, or the use of such premium8
rates.9
(14) "Index rate" means for each class of business for small employers with10
similar case characteristics the arithmetic average of the applicable base premium11
rate and the corresponding highest premium rate.12
(15) "Individual health insurance coverage" or "individual policy" means13
health insurance coverage offered to individuals in the individual market or through14
an association.15
(16) "Insured" includes any policyholder, including a dependent, enrollee,16
subscriber, or member, who is covered through any policy or subscriber agreement17
offered by a health insurance issuer.18
(17) "Large group" or "large employer" means any person, firm, corporation,19
partnership, or association actively engaged in business which employs more20
employees than is able to qualify for a small group under this Section.21
(18) "Medical loss ratio" means the ratio of expected incurred benefits to22
expected earned premium over the time period of coverage, subject to the23
requirements of federal statute, regulation, or rule.24
(19) "New business premium rate" means, for each class of business as to25
a rating period, the premium rate charged or offered by the small employer health26
insurance issuer to small employers with similar case characteristics for newly issued27
health benefits plans with the same or similar coverage.28 HLS 12RS-997 ORIGINAL
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(20) "New premium rate filing" means any particular product which has not1
been issued or delivered in this state.2
(21) "Particular product" means a basic insurance policy form, certificate,3
or subscriber agreement delineating the terms, provisions, and conditions of a4
specific type of coverage or benefit under a particular type of contract with a discrete5
set of rating and pricing methodologies that a health insurance issuer offers in the6
state.7
(22) "Premium rate" means the rate initially filed or filed as a result of a rate8
change by a health insurance issuer for a particular product.9
(23) "Rate change" means whenever rates for any health insurance issuer for10
a particular product differ from the rates on file with the department; including any11
change in any current rating factor, periodic recalculation of experience, change in12
rate calculation methodology, change in benefits, or change in the trend or other13
rating assumptions.14
(24) "Rate increase" means any increase of the rates for a particular product.15
When referring to federal review thresholds, a rate increase includes a premium16
volume–weighted average increase for all insureds for the aggregate rate changes17
during the twelve-month period preceding the proposed rate increase effective date.18
(25) "Rating factors" mean demographic or other relevant characteristics19
which are considered by the health insurance issuer in the determination of premium20
rates for a particular product.21
(26) "Rating period" means the calendar period for which premium rates22
established by a health insurance issuer are in effect.23
(27) "Small group" or "small employer" means any person, firm,24
corporation, partnership, trust or association actively engaged in business which has25
employed an average of at least one but not more than fifty employees, and26
beginning on January 1, 2014, at least one but not more than one hundred employees,27
on business days during the preceding calendar year or plan year and who employs28
at least one employee on the first day of the plan year. Small group or small29 HLS 12RS-997 ORIGINAL
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employer shall include coverage sold to small groups or small employers through1
associations or through a blanket policy. An employer group of one shall be2
considered individual insurance under this Subpart.3
(28) "Unfairly discriminatory" means premium rates that result in premium4
differences between insureds within similar risk categories that do not reasonably5
correspond to differences in expected costs. When applied to premium rates6
charged, "unfairly discriminatory" shall refer to any premium rate charged by small7
group or individual health insurance issuers in violation of R.S. 22:1095.8
(29) "Unjustified" means a premium rate for which a health insurance issuer9
has provided data or documentation to the Department in connection with premium10
rates for a particular product that are incomplete, inadequate, or otherwise do not11
provide a basis upon which the reasonableness of a premium rate may be determined12
or is otherwise inadequate insofar as the premium rate charged is clearly insufficient13
to sustain projected losses and expenses. 14
(30) "Unreasonable" means any premium rate that contains a provision or15
provisions that are any of the following:16
(a) Excessive.17
(b) Unfairly discriminatory.18
(c) Unjustified.19
(d) Otherwise not in compliance with the provisions of this Title or this20
Subpart.21
§1092. Restrictions relating to premium rates; health insurance Health insurance22
issuers; premium rate filings and rate increases23
A. Premium rates for group health benefit plans subject to R.S. 22:109124
through 1094 shall be subject to the following provisions:25
(1) The index rate for a rating period for any class of business shall not26
exceed the index rate for any other class of business by more than twenty percent.27
(2) For a class of business, the premium rates charged during a rating period28
to any employer with similar case characteristics for the same or similar coverage,29 HLS 12RS-997 ORIGINAL
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or the rates which could be charged to such employer under the rating system for that1
class of business, whether new coverage or renewal coverage, shall not vary from the2
index rate by more than thirty-three percent of the index rate.3
(3) The percentage increase in the premium rate charged to a small employer4
for a new rating period may not exceed the sum of the following:5
(a) The percentage change in the new business premium rate measured from6
the first day of the prior rating period to the first day of the new rating period. In the7
case of a class of business for which the small employer carrier is not issuing new8
policies, the carrier shall use the percentage change in the base premium rate.9
(b) An adjustment, not to exceed twenty percent annually and adjusted pro10
rata for rating periods of less than one year, due to one or a combination of the11
following: claim experience, health status, or duration of coverage of the employees12
or dependents of the small employer as determined from the carrier's rate manual for13
the class of business.14
(c) Any adjustment due to change in coverage or change in the case15
characteristics of the small employer as determined from the carrier's rate manual for16
the class of business.17
B. Nothing in this Section is intended to affect the use by a small employer18
carrier of legitimate rating factors other than claim experience, health status, or19
duration of coverage in the determination of premium rates. Small employer carriers20
shall apply rating factors, including case characteristics, consistently with respect to21
all small employers in a class of business.22
C. A small employer carrier shall not involuntarily transfer a small employer23
into or out of a class of business. A small employer carrier shall not offer to transfer24
a small employer into or out of a class of business unless such offer is made to25
transfer all small employers in the class of business without regard to case26
characteristics, claim experience, health status or duration since issue.27
A. Proposed premium rate filings. Every health insurance issuer shall file28
with the department every proposed premium rate to be used in connection with29 HLS 12RS-997 ORIGINAL
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particular products. Every such filing shall clearly state the date of the filing, the1
proposed premium rate, and the effective date of the proposed premium rate. All2
such filings shall be made electronically or as otherwise instructed by the3
department. All premium rate filings required by this Section shall be made in4
accordance with the following:5
(1) Premium rate filings shall be made no less than one hundred five days6
in advance of the proposed effective date unless otherwise waived by the department.7
(2) All health insurance issuers assuming, merging, or acquiring blocks of8
business shall be considered as proposing new premium rates.9
B. Contents of proposed premium rate filings.10
(1) All premium rate filings shall include each of the following:11
(a) An actuarial memorandum, including the actuarial certification, that12
provides justification for the proposed premium rate and all underlying assumptions.13
(b) Sufficient information to support the reasonableness of the premium rate14
including but not limited to valid company experience, when possible.15
(c) For a proposed rate increase, health insurance issuers shall submit each16
of the following:17
(i) A rate increase summary.18
(ii) A written description justifying the rate increase.19
(d) Any and all relevant information required by the department.20
(2) When a premium rate filing made pursuant to this Section is not21
accompanied by the information upon which the health insurance issuer supports the22
premium rate filing, and the department does not have sufficient information to23
determine whether the premium rate filing meets the requirements of this Section,24
it shall require the health insurance issuer to re-file the information upon which it25
supports its filing. The time period provided in this Section shall start over and26
commence as of the date the proper information is furnished to the department.27 HLS 12RS-997 ORIGINAL
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C. Compliance with R.S. 22:1095. All proposed premium rate filings shall1
be reviewed for compliance with R.S. 22:1095. Any proposed premium rate filings2
which are not in compliance with R.S. 22:1095 shall not be approved.3
D. Premium rate filing review. All premium rate filings shall be reviewed4
by the department to determine whether such filing is unreasonable and compliant5
with this Subpart.6
E. Unreasonableness. Any and all premium rates shall comply with each of7
the following Paragraphs:8
(1) The department shall consider any of the following criteria to determine9
whether premium rates are unreasonable:10
(a) The premium rate is excessive.11
(b) The premium rate is unfairly discriminatory.12
(c) The premium rate is unjustified.13
(d) The premium rate does not otherwise comply with the provisions of this14
Subpart.15
(2) Criteria for unreasonable premium rates. The review of any proposed16
premium rate may take into consideration the following factors, to the extent17
applicable, to determine whether the filing under review is unreasonable:18
(a) The impact of medical trend changes by major service categories.19
(b) The impact of utilization changes by major service categories.20
(c) The impact of cost-sharing changes by major service categories.21
(d) The impact of benefit changes.22
(e) The impact of changes in an insured’s risk profile.23
(f) The impact of any overestimate or underestimate of medical trend for 24
prior year periods related to the rate increase, if applicable.25
(g) The impact of changes in reserve needs.26
(h) The impact of changes in administrative costs related to programs that27
improve health care quality.28
(i) The impact of changes in other administrative costs.29 HLS 12RS-997 ORIGINAL
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(j) The impact of changes in applicable taxes or licensing or regulatory fees.1
(k) Medical loss ratio. 2
(l) The financial performance of the health insurance issuer, including capital3
and surplus levels.4
F. Public comment. Within fifteen days of submission of any proposed rate5
increase which meets or exceeds the federal review threshold, the department shall6
publish a summary consistent with Items (B)(1)(c)(i) and (ii) of this Section of the7
rate increase information provided by the health insurance issuer on the department’s8
website. After publication, the public shall have thirty days to submit comments.9
G. Disapproval. The department shall disapprove a proposed premium rate10
filings if it finds the premium rate is unreasonable.11
H. Notification of approval or disapproval. The department shall notify the12
health insurance issuer in writing whether it approves or disapproves a proposed13
premium rate filing. Such notice shall be in writing and be made within sixty days14
of the filing. If the department disapproves a proposed premium rate filing, then the15
written notice shall clearly state the reasons why such proposed premium rate filing16
was disapproved. 17
I. For any rate increase that meets or exceeds the federal review threshold,18
the department shall, upon request by the secretary of the federal Department of19
Health and Human Services, provide its final determination with respect to20
unreasonableness to the Centers for Medicare and Medicaid Services in a manner21
and form prescribed along with a brief explanation of the final determination. The22
department shall post a notice of the final determination on its website. 23
J. Implementation of rates. A health insurance issuer may implement a24
proposed new premium rate filing approved by the department upon approval and25
proposed rate increases no sooner than forty-five days after the written approval in26
order for the insured to be notified pursuant to R.S. 22:1093. Any premium rate27
filing approved by the department shall be implemented within ninety days of notice28
of approval. Any premium rate not implemented within ninety days of notice of29 HLS 12RS-997 ORIGINAL
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approval shall be void and any health insurance issuer seeking to implement the1
premium rate thereafter shall be required to file a new premium rate filing in2
compliance with this Section.3
K. Request for a hearing. Any aggrieved health insurance issuer may file4
within thirty days a written request for a hearing with the Nineteenth Judicial District5
Court for a de novo review.6
L. Premium rate filings made by health insurance issuers under this Section7
shall be subject to the Public Records Law, R.S. 44:1 et seq., and the restrictions on8
health information under R.S. 22:42.1. The department shall publish for public9
comment, pursuant to Subsection F of this Section, a summary of the rate increases10
and written justification of the same, which do not constitute proprietary or trade11
secret information.12
§1093. Disclosure of rating practices and renewability provisions for insureds13
A. Each carrier shall make reasonable disclosure in solicitation and sales14
materials provided to small employers of the following:15
(1) The extent to which premium rates for a specific small employer are16
established or adjusted due to the claim experience, health status or duration of17
coverage of the employees or dependents of the small employer.18
(2) The provisions concerning the carrier's right to change premium rates and19
the factors, including case characteristics, which affect changes in premium rates.20
(3) A description of the class of business in which the small employer is or21
will be included, including the applicable grouping of plans.22
(4) The provisions relating to renewability of coverage.23
B. Each carrier shall provide a reasonable explanation of any rate increase24
no less than forty-five days prior to the effective date of such increase. Such25
explanation shall indicate the contributing factors resulting in an increased premium,26
which may include but not be limited to experience, medical cost, and demographic27
factors.28 HLS 12RS-997 ORIGINAL
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A. Each health insurance issuer shall make reasonable disclosure in1
solicitation and sales materials provided to small employers of each of the following:2
(1) The extent to which premium rates for a specific small employer are3
established or adjusted due to the claim experience, health status, or duration of4
coverage of the employees or dependents of the small employer.5
(2) The provisions concerning the health insurance issuer's right to change6
premium rates and the factors, including case characteristics, which affect changes7
in premium rates.8
(3) A description of the class of business in which the small employer is or9
will be included, including the applicable grouping of plans.10
(4) The provisions relating to renewability of coverage.11
B. Each health insurance issuer shall provide its insureds a written notice of12
a reasonable explanation of reasonable explanation of any rate increase no less than13
forty-five days prior to the effective date of such increase. Such explanation shall14
indicate the contributing factors for the rate increase, which may include the written15
description justifying the rate increase as required by R.S. 22:1092(B)(1)(c).16
§1094. Maintenance of records for the department17
A. Each small employer carrier health insurance issuer shall maintain at its18
principal place of business a complete and detailed description of its rating practices19
and renewal underwriting description of its rating practices and renewal underwriting20
practices, including information and documentation which demonstrate that its rating21
methods and practices are based upon commonly accepted actuarial assumptions and22
are in accordance with sound actuarial principles and the rules and regulations of the23
department.24
B. Each small employer carrier health insurance issuer shall file each March25
first with the commissioner department an actuarial certification that the carrier26
health insurance issuer is in compliance with this Section Subpart and that the rating27
methods of the carrier health insurance issuer are actuarially sound. A copy of such28 HLS 12RS-997 ORIGINAL
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certification shall be retained by the carrier health insurance issuer at its principal1
place of business.2
C. A small employer carrier health insurance issuer shall make the3
information and documentation described in Subsection A of this Section available4
to the commissioner department for inspection upon request. The information shall5
be considered proprietary and trade secret information , and shall not be subject to6
disclosure by the commissioner department to persons outside of the department7
except as agreed to by the carrier health insurance issuer or as ordered by a court of8
competent jurisdiction., and shall not be subject to disclosure under the Public9
Records Law.10
§1095. Restrictions relating to premium rates; Modified modified community11
rating; health insurance premiums; compliance with rules and regulations12
rating factors 13
A. Each small group and individual health and accident insurer shall14
maintain at its principal place of business a complete and detailed description of its15
rating practices and a renewal underwriting description of its rating practices and16
renewal underwriting practices, including information and documentation which17
demonstrate that its rating methods and practices are in full and complete compliance18
with the rules and regulations promulgated by the Department of Insurance for a19
modified community rating system for health insurance premiums.20
B.(1) The Department of Insurance shall promulgate regulations no later than21
January 1, 1994, that provide criteria for the community rating of premiums for any22
hospital, health, or medical expense insurance policy, hospital or medical service23
contract, health and accident policy or plan, or any other insurance contract of this24
type, that is small group or individually written.25
(2)(a) The regulations shall place limitations upon the following26
classification factors used by any insurer or group in the rating of individuals and27
their dependents for premiums:28
(i) Medical underwriting and screening.29 HLS 12RS-997 ORIGINAL
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(ii) Experience and health history rating.1
(iii) Tier rating.2
(iv) Durational rating.3
(b) The premiums charged shall not deviate according to the classification4
factors in Subparagraph (a) of this Paragraph by more than plus or minus thirty-three5
percent for individual health insurance policies or subscriber agreements. In no6
event shall the increase in premiums for a small employer group policy vary from7
the index rate by plus or minus thirty-three percent.8
(3) The following classification factors may be used by any small group or9
individual insurance carrier in the rating of individuals and their dependents for10
premiums:11
(a) Age.12
(b) Gender.13
(c) Industry.14
(d) Geographic area.15
(e) Family composition.16
(f) Group size.17
(g) Tobacco usage.18
(h) Plan of benefits.19
(i) Other factors approved by the Department of Insurance.20
C. Any small group and individual insurance carrier that varies rates by21
health status, claims experience, duration, or any other factor in conflict with the22
regulations promulgated by the Department of Insurance shall establish a phase-out23
rate adjustment as of the first renewal date on or after January 1, 2002, for each24
entity insured by the carrier in order to come into compliance with this Section25
pursuant to the regulations promulgated by the Department of Insurance.26
D. The provisions of this Section shall not apply to limited benefit health27
insurance policies or contracts.28 HLS 12RS-997 ORIGINAL
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A. Premium rates for health benefit plans in the small group market shall be1
subject to the following provisions:2
(1) The index rate for a rating period for any class of business shall not3
exceed the index rate for any other class of business by more than twenty percent.4
(2) For a class of business, the premium rates charged during a rating period5
to any employer with similar case characteristics for the same or similar coverage,6
or the premium rates which could be charged to such employer under the rating7
system for that class of business, whether new coverage or renewal coverage, shall8
not vary from the index rate by more than thirty-three percent of the index rate.9
(3) The percentage increase in the premium rate charged to a small employer10
for a new rating period may not exceed the sum of the following:11
(a) The percentage change in the new business premium rate measured from12
the first day of the prior rating period to the first day of the new rating period. In the13
case of a class of business for which the small employer health insurance issuer is14
not issuing new policies, the health insurance issuer shall use the percentage change15
in the base premium rate.16
(b) An adjustment, not to exceed twenty percent annually and adjusted pro17
rata for rating periods of less than one year, due to one or a combination of the18
following: claim experience, health status, or duration of coverage of the employees19
or dependents of the small employer as determined from the health insurance issuer's20
rate manual for the class of business.21
(c) Any adjustment due to change in coverage or change in the case22
characteristics of the small employer as determined from the health insurance issuer's23
rate manual for the class of business.24
B. Nothing in this Section is intended to affect the use by a small employer25
health insurance issuer of legitimate rating factors other than claim experience,26
health status, or duration of coverage in the determination of premium rates. Small27
employer health insurance issuers shall apply rating factors, including case28
characteristics, consistently with respect to all small employers in a class of business.29 HLS 12RS-997 ORIGINAL
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C. A small employer health insurance issuer shall not voluntarily transfer a1
small employer into or out of a class of business. A small employer health insurance2
issuer shall not offer to transfer a small employer into or out of a class of business3
unless such offer is made to transfer all small employers in the class of business4
without regard to case characteristics, claim experience, health status or duration5
since issue.6
D.(1) Health insurance issuers in the small group and individual markets7
shall adhere to regulations promulgated by the department which place limitations8
on the use of the following classification factors used in the rating of individuals and9
their dependents for premiums:10
(i) Medical underwriting and screening.11
(ii) Experience and health history rating.12
(iii) Tier rating.13
(iv) Durational rating.14
(2) The premiums charged shall not deviate according to the classification15
factors in Subparagraph (1) of this Subsection by more than plus or minus16
thirty-three percent for particular products in the individual market. In no event shall17
the increase in premium rates for a small employer group policy vary from the index18
rate by plus or minus thirty-three percent.19
(3) The following classification factors may be used by any small group or20
individual health insurance issuer in the rating of individuals and their dependents21
for premium rates:22
(a) Age.23
(b) Gender.24
(c) Industry.25
(d) Geographic area.26
(e) Family composition.27
(f) Group size.28
(g) Tobacco usage.29 HLS 12RS-997 ORIGINAL
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(h) Plan of benefits.1
(i) Other factors approved by the department.2
§1096. Health and accident insurers; rate increases Regulations3
Health and accident insurers shall not increase their premium rates during the4
initial twelve months of coverage and not more than once in any six-month period5
following the initial twelve-month period, for any policy, rider, or amendment issued6
in or for residents of the state, no matter the date of commencement or renewal of the7
insurance coverage except that no health insurance issuer or health maintenance8
organization issuing group or individual policies or subscriber agreements shall9
increase its premium rates or reduce the covered benefits under the policy or10
subscriber agreement after the commencement of the minimum one-hundred-eighty-11
day period described in R.S. 22:1068(C)(2)(a)(i) or 1074(C)(2)(a)(i). This Section12
does not affect increases in the premium amount due to the addition of a newly13
covered person or a change in age or geographic location of an individual insured or14
policyholder or an increase in the policy benefit level.15
The commissioner may promulgate such rules and regulations as may be16
necessary and proper to carry out the provisions of this Subpart. Such rules and17
regulations shall be promulgated and adopted in accordance with the Administrative18
Procedure Act.19
§1097. Discrimination in rates or failure to provide coverage because of severe20
disability or sickle cell trait prohibited Enforcement21
A. No insurance company shall charge unfair discriminatory premiums,22
policy fees or rates for, or refuse to provide any policy or contract of life insurance,23
life annuity, or policy containing disability coverage for a person solely because the24
applicant therefor has a severe disability, unless the rate differential is based on25
sound actuarial principles or is related to actual experience. No insurance company26
shall unfairly discriminate in the payments of dividends, other benefits payable under27
a policy, or in any of the terms and conditions of such policy or contract solely28
because the owner of the policy or contract has a severe disability.29 HLS 12RS-997 ORIGINAL
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B. "Severe disability", as used in this Section, means any disease of, or1
injury to, the spinal cord resulting in permanent and total disability, amputation of2
any extremity that requires prosthesis, permanent visual acuity of twenty/two3
hundred or worse in the better eye with the best correction, or a peripheral field so4
contracted that the widest diameter of such field subtends an angular distance no5
greater than twenty degrees, total deafness, inability to hear a normal conversation6
or use a telephone without the aid of an assistive device, or persons who have7
developmental disabilities, including but not limited to autism, cerebral palsy,8
epilepsy, mental retardation, and other neurological impairments.9
C. Nothing in this Section shall be construed as requiring an insurance10
company to provide insurance coverage against a severe disability which the11
applicant or policyholder has already sustained.12
D. No insurance company shall charge unfair discriminatory premiums,13
policy fees or rates for, or refuse to provide any policy or contract of life insurance,14
life annuity, or policy containing disability coverage for a person solely because the15
applicant therefor has sickle cell trait. No insurance company shall unfairly16
discriminate in the payments of dividends, other benefits payable under a policy, or17
in any of the terms and conditions of such policy or contract solely because the18
insured of the policy of contract has sickle cell trait. Nothing in this Subsection shall19
prohibit waiting periods, pre-existing conditions, or dreaded disease rider exclusions,20
or any combination thereof, if they do not unfairly discriminate.21
§1097. Enforcement22
A. Whenever the commissioner has reason to believe that any health23
insurance issuer is not in full compliance with the provisions of R.S. 22:1091 et seq.,24
excluding disapproval by the commissioner as provided in R.S. 22:1092(C) and (G),25
he shall notify such person. Upon such notice, the commissioner may, in addition26
to the penalties in Subsection C of this Section, issue and cause to be served an order27
requiring the health insurance issuer to cease and desist from any violation.28 HLS 12RS-997 ORIGINAL
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B. Penalties for violation of a cease and desist order. Any health insurance1
issuer who violates a cease and desist order issued by the commissioner pursuant to2
this Subpart while such order is in effect shall be subject at the discretion of the3
commissioner to any one or more of the following:4
(1) A monetary penalty of not more than twenty-five thousand dollars for5
each and every act or violation and every day the health insurance issuer is not in6
compliance with the cease and desist order, not to exceed an aggregate of two7
hundred fifty thousand dollars.8
(2) Suspension or revocation of the health insurance issuer's certificate of9
authority to operate in this state.10
(3) Injunctive relief from the district court of the district in which the11
violation may have occurred or in the Nineteenth Judicial District Court.12
C. Penalties for violation of this Subpart. As a penalty for violating this13
Subpart, the commissioner may refuse to renew, suspend, or revoke the certificate14
of authority of any health insurance issuer, or in lieu of suspension or revocation of15
a certificate of authority, the commissioner may levy a monetary penalty of not more16
than one thousand dollars for each and every act or violation, not to exceed an17
aggregate of two hundred fifty thousand dollars.18
D. An aggrieved party affected by the commissioner's decision, act, or order19
may demand a hearing in accordance with Chapter 12 of this Title, R.S. 22:2191 et20
seq. If a health insurance issuer has demanded a timely hearing, the penalty, fine,21
or order by the commissioner shall not be imposed until such time as the Division22
of Administrative Law makes a finding that the penalty, fine, or order is warranted23
in a hearing, held in the manner provided in Chapter 12 of this Title.24
§1098. Frequency of rate increase limitations25
A. The provisions of this Section shall apply to all health benefit plans,26
limited benefits, and excepted benefits. Health insurance issuers shall not increase27
their premium rates during the initial twelve months of coverage and not more than28
once in any six month period following the initial twelve-month period, for any29 HLS 12RS-997 ORIGINAL
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policy, subscriber agreement, rider, or amendment issued in or for residents of the1
state, no matter the date of commencement or renewal of the health insurance2
coverage. 3
B. No health insurance issuer issuing policies or subscriber agreements shall4
increase its premium rates or reduce the covered benefits under the policy or5
subscriber agreement after the commencement of the minimum one- hundred -eighty6
day-period following the notice of the discontinuation of offering all health insurance7
coverage as described in R.S. 22:1068(C)(2)(a)(i) or 1074(C)(2)(a)(i). 8
C. This Section shall not affect increases in the premium amount due to any9
change due to compliance with the addition of a newly covered person or policy10
benefit level, or such changes necessary to comply with R.S. 22:1095 or other federal11
or state law, regulation, or rule.12
§1099. Discrimination in rates or failure to provide coverage because of severe13
disability or sickle cell trait prohibited 14
A. No insurance company shall charge unfair discriminatory premiums,15
policy fees or rates for, or refuse to provide any policy or contract of life insurance,16
life annuity, or policy containing disability coverage for a person solely because the17
applicant therefor has a severe disability, unless the rate differential is based on18
sound actuarial principles or is related to actual experience. However, health19
insurance issuers subject to this Subpart et seq. may not, regardless of actuarial20
principles or actual experience, unfairly discriminate in violation of this Subpart or21
federal law. No insurance company shall unfairly discriminate in the payments of22
dividends, other benefits payable under a policy, or in any of the terms and23
conditions of such policy or contract solely because the owner of the policy or24
contract has a severe disability.25
B. "Severe disability", as used in this Section, means any disease of or injury26
to the spinal cord resulting in permanent and total disability, amputation of any27
extremity that requires prosthesis, permanent visual acuity of twenty/two hundred28
or worse in the better eye with the best correction, or a peripheral field so contracted29 HLS 12RS-997 ORIGINAL
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that the widest diameter of such field subtends an angular distance no greater than1
twenty degrees, total deafness, inability to hear a normal conversation or use a2
telephone without the aid of an assistive device, or persons who have developmental3
disabilities, including but not limited to autism, cerebral palsy, epilepsy, mental4
retardation, and other neurological impairments.5
C. Nothing in this Section shall be construed as requiring an insurance6
company to provide insurance coverage against a severe disability which the7
applicant or policyholder has already sustained.8
D. No insurance company, including health insurance issuers subject to this9
Subpart, shall charge unfair discriminatory premiums, policy fees, or rates for, or10
refuse to provide any policy, subscriber agreement, or contract of life insurance, life11
annuity, or policy containing disability coverage for a person solely because the12
applicant therefor has sickle cell trait. No insurance company, including health13
insurance issuers subject to this Subpart, shall unfairly discriminate in the payments14
of dividends, other benefits payable under a policy, or in any of the terms and15
conditions of such policy or contract solely because the insured of the policy of16
contract has sickle cell trait. Nothing in this Subsection shall prohibit waiting17
periods, pre-existing conditions, or dreaded disease rider exclusions, or any18
combination thereof, as may be permitted by federal law.19
Section 2. R.S. 22:1093(A) and 1095, both as amended by Section 1 of this20
Act, are hereby enacted to read as follows: 21
§1093. Disclosure of rating practices and renewability provisions for insureds22
A. Each health insurance issuer shall make reasonable disclosure in23
solicitation and sales materials provided to insureds of the following:24
(1) The extent to which premium rates are established or adjusted due to25
claim experience.26
(2) The provisions concerning the health insurance issuer's right to change27
premium rates and the rating factors, which affect changes in premium rates.28 HLS 12RS-997 ORIGINAL
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(3) The provisions relating to renewability of coverage.1
* * *2
§1095. Rating factors 3
A. Health insurance issuers shall vary premium rates, whether new or upon4
renewal, with respect to a particular product for individuals or in a small group only5
by one or more of the following:6
(1) Whether such product or coverage covers an individual or family.7
(2) Rating area, as established in accordance with Subsection D of this8
Section.9
(3) Age, except that such premium rate shall not vary by more than three to10
one for adults.11
(4) Tobacco use, except that such rate shall not vary by more than one and12
one half to one.13
B. No premium rate shall vary with respect to a particular product or14
coverage involved by any other factor not listed in Subsection A of this Section.15
C. With respect to coverage issued to members within a family under a small16
group plan, the rating variations permitted under Paragraphs (A)(3) and (4) of this17
Section shall be applied based on the portion of the premium that is attributable to18
each family member covered under the plan or coverage.19
D. The department shall determine by rule or regulation the geographic area20
or areas to be used for the state of Louisiana.21
E. Any premium rate proposed to be used by a health insurance issuer shall22
be submitted and controlled by this Subpart.23
Section 3. R.S. 44:4.1(B)(10) is hereby amended and reenacted to read as24
follows:25
§4.1. Exceptions26
* * *27
B. The legislature further recognizes that there exist exceptions, exemptions,28
and limitations to the laws pertaining to public records throughout the revised29 HLS 12RS-997 ORIGINAL
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statutes and codes of this state. Therefore, the following exceptions, exemptions, and1
limitations are hereby continued in effect by incorporation into this Chapter by2
citation:3
* * *4
(10) R.S. 22:2, 14, 42.1, 88, 244, 461, 572, 572.1, 574, 618, 706, 732, 752,5
771, 1092, 1094,1203, 1460, 1466, 1546, 1644, 1656, 1723, 1927, 1929, 1983, 1984,6
2036, 23037
* * *8
Section 4. The provisions of R.S. 22:1091(B)(2), (3), (4), (14), and (19),9
1093(A) and 1095, all as amended by Section 1 of this Act, shall be effective until10
January 1, 2014. 11
Section 5. The provisions of this Section and Sections 1, 3, 4, and 6 of this12
Act shall become effective upon signature by the governor or, if not signed by the13
governor, upon expiration of the time for bills to become law without signature by14
the governor, as provided by Article III, Section 18 of the Constitution of Louisiana.15
If vetoed by the governor and subsequently approved by the legislature, this Act shall16
become effective on the day following such approval.17
Section 6. The provisions of Section 2 of this Act shall become effective on18
January 1, 2014. 19
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Ritchie HB No. 908
Abstract: Provides for review and approval of rates of health insurance issuers, including
health maintenance organizations (HMOs) and brings present law relative to such
review into compliance with the federal Patient Protection and Affordable Care Act
(PPACA).
Proposed law provides for health insurance rate review and approval as follows:
(1)Present law provides for the approval and disapproval of health and accident
insurance forms and policies by the commissioner of insurance.
Proposed law increases the time for use of forms from 45 days to 60 days after filing. HLS 12RS-997 ORIGINAL
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(2)Present law provides rate limitations for health benefit plans for small employers and
individuals. Provides for rating factors and sets allowable percentages of annual
increases. Requires each small group and individual health and accident insurer to
make reasonable disclosure of rates to small employers and provides required
content of each disclosure. Further provides that when a rate increase occurs, the
insurer shall provide a reasonable explanation of any increase. Also requires each
insurer to maintain records of its rating practices and to certify to the commissioner
that it is in compliance with the rating requirements. Prohibits health and accident
insurers from increasing their premiums except as provided in present law. Excludes
group and individual high deductible health plans from the rate limitations and
requirements.
Proposed law makes rate review and approval requirements applicable to health
benefit plans which provide coverage to large groups in addition to individual and
small group entities. Provides that certain rating restrictions shall become effective
January 1, 2014, and phases in certain criteria and factors relating to rates and rate
increases. Provides for fees for proposed premium rate filings and rates changes.
Lists and identifies those benefits not subject to the requirements. Additionally
includes HMOs and any entity that offers health insurance coverage through a
policy, certificate of insurance, or subscriber agreement subject to state law that
regulates the business of insurance, which includes small groups, large groups, and
individuals. Requires premium rate filings with the department, made under certain
time lines, subject to certain fees, and containing certain information. Specifies that
premium rate filings shall be reviewed by the department for compliance. Lists
certain criteria and factors to be used to determine if the premium rates are
unreasonable. Requires publication of any proposed rate increase which meets or
exceeds the federal review threshold to allow for public comment. Makes certain
information submitted to the department exempt from the Public Records Law.
(3)Provides that if the commissioner determines that any health insurance issuer is not
in compliance with the rate review provisions, he may issue penalties or issue cease
and desist orders. Sets monetary penalties violation of cease and desist orders. Also
authorizes the commissioner to revoke, suspend, or fail to renew authority of any
health insurance issuer to conduct business in this state for noncompliance. Gives
any aggrieved health insurance issuer the opportunity to seek a judicial hearing to
review the department’s decisions on these matters.
(4)Present law prohibits unfair discrimination in rates or failure to provide life, life
annuity, or disability coverage because of severe disability or sickle cell trait.
Proposed law retains this prohibition and additionally prohibits such unfair
discrimination by health insurance issuers.
Effective upon signature of the governor or lapse of time for gubernatorial action; however,
certain provisions expire or become effective January 1, 2014.
(Amends R.S. 22:972 and 1091-1099 and R.S. 44:4.1(B)(10); Adds R.S. 22:821(B)(34))